HOW THE WHO SETS THE 'PANDEMIC ALERT LEVEL'
DR NIMAN WATCHES THE WATCHERS OF BIRD FLU
The New York Times is reporting that the recent Indonesian 'cluster' of seven bird flu deaths, from the same family, may mask a deeper and more troubling spread of the virus through human-t0-human infections.
That countries like Indonesia, or China, are completely honest and utterly transparent in their acknolwedgement of human bird flu infections is essential to determining just how close the world may be coming to the much dreaded human pandemic.
There is still no sign that the pandemic has begun, in Indonesia, or any other country, but the deaths continue to mount, three to five more every week.
Tiny numbers, of course, compared to the spread of AIDS, TB and other deadly infectious viruses, but the 130+ plus deaths confirmed so far may not tell the true story of just how many have died from bird flu, let alone how many have been infected and survived.
It is the 'clusters' that trouble the watchdogs, like the World Health Organisation, the most.
When the 'clusters' are locked into family, or even tight village communities, then the WHO can claim that close, or intimate, contact is the cause of the virus jumping from one person to another. They can claim that the virus is not transmitting "easily" from human to human.
But if 'clusters' begin to light up across cities, across countrysides, then it will be a sign that a epidemic, or pandemic, is far more likely.
Last Tuesday, according to the New York Times, Maria Cheng, a W.H.O. spokeswoman, said there were "probably about half a dozen (clusters)". I don't think anybody's got a solid number."
This number is more than the "three or so" the WHO has previously admitted to, and it is well below the number that an independent 'bird flu virus' watcher like Dr Henry Niman claims is the reality.
...Dr. Angus Nicoll, chief of flu activities at the European Center for Disease Prevention and Control, acknowledged that "we are probably underestimating the extent of person-to-person transmission."
Most clusters are hard to investigate...because they may not even be noticed until a victim is hospitalized, and are often in remote villages where people fear talking. Also, he said, by the time doctors from Geneva arrive to take samples, local authorities "have often killed all the chickens and covered everything with lime."
The W.H.O. is generally conservative in its announcements and, as a United Nations agency, is sometimes limited by member states in what it is permitted to say about them.
Still, several scientists have noted that there are many clusters in which human-to-human infection may be a more logical explanation than the idea that relatives who fell sick days apart got the virus from the same dying bird.
Dr. Henry L. Niman, a biochemist in Pittsburgh who has become a hero to many Internet flu watchers and a gadfly to public health authorities, has argued for weeks that there have been 20 to 30 human-to-human infections.
Dr. Niman says the authors of the Emerging Infectious Diseases article were too conservative: even though the dates in it were fragmentary, it was possible to infer that in about 10 of the 15 cases, there was a gap in onset dates of at least five days, which would fit with the flu's incubation time of two to five days.
And in a study published just last month about a village in Azerbaijan, scientists from the W.H.O. and the United States Navy said human-to-human transmission was possible. That conclusion essentially agreed with what Dr. Niman had been arguing since early March — that it was unlikely that seven infections among six relatives and a neighbor, with onset dates stretching from Feb. 15 to March 4, had all been picked up from dying wild swans that the family had plucked for feathers in a nearby swamp in early February.
The W.H.O. at first said (in relation to the most recent Indonesian 'cluster') an undercooked pig might have infected the whole family, but Dr. Niman discovered that the hostess of the barbecue was sick two days before the barbecue and the last relative was infected two weeks after it.
His prodding, picked up by journalists, eventually led the W.H.O. to concede that no pig was to blame and that the virus probably had jumped from human to human to human.
Dr. David Nabarro, chief pandemic flu coordinator for the United Nations, said that even if some unexplained cases were human-to-human, it does not yet mean that the pandemic alert system, now at Level 3, "No or very limited human-human transmission," should be raised to Level 4, "Increased human-human transmission."
Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is "very inefficient."
Level 6, meaning a pandemic has begun, is defined as "efficient and sustained" human transmission.
Ms. Cheng of the W.H.O. said that even if there were more clusters, the alert would remain at Level 3 as long as the virus dies out by itself.
"A lot of this is subjective, a judgment on how efficiently the virus is infecting people," she said. "If it becomes more common, we'd convene a task force to raise the alert level."
But how long will that take?
And will the impact on global stock markets of such a raising of the alert level enter into consideration of how and when this news is made public?
If, that is, they ever see the need to do so.
The spread of infections do not appear, today at least, to warrant such a rise in the alert levels, and the infection rates may never warrant such action to ever be taken.
Although there is no proof that such considerations would affect the W.H.O's ratcheting up of the Pandemic Alert Level, the mere possibility that the most recent Indonesian 'cluster' might have signalled a change by the WHO from Pandemic Alert Level 3 to Level 4, or higher, smacked the Indonesian currency hard, and lopped hundreds of millions off the value of stock related to airlines and travel companies.
Investors feared such a raising of the Pandemic Alert Level would affect the Indonesian tourist industry, and airline travel to the region in general. Many bailed.
The W.H.O won't raise their Pandemic Alert Level until they have totally quantifiable proof that the bird flu virus is transmitting between humans more easily, but this appears to also be a matter of interpretation of the available data.
There are no set guidelines, besides the vague wording mentioned in the quotes above, as to how the Alert Levels are determined.
It will be a decision made, presumably, around a table by experts. There may be arguments, there may be major disagreements.
When the decision has to be made, if it ever has to be made, it won't be made easily, or quickly.
But when they do see a need to move from Level Three to Four, a lot of money is going to be lost very, very fast on the stock and currency speculation markets.
This is troubling, because the pressure will now be on the health officials of countries like Indonesia to make sure that any truly bad news about bird flu spreading faster, and more easily, amongst humans is either delayed, played down or covered up completely.
That doesn't mean Indonesian health officials will cave in to such pressure and attempt to smokescreen the bad news.
But it's going to be a multi-billion dollar decision when (and if) it comes.
The W.H.O. can only maintain a certain level of awareness of how the virus may be spreading through Indonesia.
It can't be everywhere all at once, but the Indonesian government will know the truth long before the W.H.O. will, if bird flu becomes first epidemic, and then pandemic, in humans.
The question now is how honest will Indonesia be if it comes down to the worst case scenario?
Perhaps Dr Niman will know before everyone else. But at least we can be pretty sure he will get the word out, and fast.
Expediency in discolsure from all concerned will be utterly vital in the event of an epidemic or pandemic of bird flu in humans.
Every hour of every day will matter deeply, particularly in stopping the virus catching a ride out of Indonesia in the lungs, or in the mouth, of one of the thousands of tourists who exit the region ever single day.
A government like that in Australia claims it can move quickly to isolate travellers arriving in the country who may be showing signs, or symptons, of bird flu infection. Such as a racking cough or a high temperature.
But the virus takes two days to a week, or more, to manifest itself and begin its destruction inisde the human body.
If bird flu in Indonesia reaches epidemic or pandemic infection levels in humans, and manages to infects a traveller returning to Australia, but at the same time Indonesia delays revealing the bad news (for fear of the crushing financial impact), it is possible the infected persons could enter Australia, exit the airports and move into the community carrying, and theoritically spreadingm the new, more deadly, far more infectious, mutation of the bird flu virus.
The WHO faces a multi-billion dollar balancing act between raising the Pandemic Alert Level too soon, or too late.
Either wrong choice will be extremely bad news. One will see a loss of billions of dollars, the other may see the loss of millions of lives.
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